［Abstract］　Objective　To explore the feasibility of performing salvage extended thymectomy for myasthenic crisis(MC) under specific conditions, and to analyze the potential theoretical mechanisms of the operation for shortening the duration of the crisis. Methods　A retrospective analysis was conducted on the clinical data of 12 patients who were admitted to Department of Thoracic Surgery, Jiangxi Provincial People′s Hospital from November 2016 to May 2024 and underwent salvage extended thymectomy for MC. Among the 12 patients, there were 5 males and 7 females. According to the modified Osserman classification, all of the patients′ diseases were classified as type Ⅲ, and their serum anti-acetylcholine receptor antibodies were positive. All of the patients received baseline drug therapy(pyridostigmine and prednisone) and adjuvant therapy(plasma exchange and intravenous gamma-globulin). Before the operation, the patients received respiratory support and the respiratory support modes included non-invasive ventilation in 1 patient and tracheal intubation with mechanical ventilation in 11 patients. Among the 11 patients receiving tracheal intubation with mechanical ventilation, 3 patients underwent tracheotomy. Results　All of the 12 patients were successfully completed the extended thymectomy for MC. The postoperative complications included recurrent laryngeal nerve injury complicated with severe pulmonary infection in 1 patient and the patient eventually died of respiratory failure, and tracheal tube obstruction leading to cardiac arrest in 1 patient. Although the cardiac arrest patient got restoration of blood circulation after cardiopulmonary resuscitation, the patient still died of hypoxic encephalopathy. The other 10 patients were discharged from the hospital smoothly and achieved relief of myasthenia gravis symptoms during a 6-month follow-up. Conclusion　Under the medical conditions such as a thoracic surgery specialty with an intensive care unit, a multidisciplinary collaborative team with rich experience in handling MC, extended thymectomy can be used as a salvage therapeutic regimen for MC and has certain feasibility, but there are still surgical risks.]]> 2025/10/31 0:00:00 LIU Yangchun, CHEN Liru, YIN Sui, ZHONG Yingmei 4true ［Abstract］　Objective　To compare the efficacy of da Vinci robot-assisted thoracoscopic surgery(RATS) in treatment of anterior mediastinal tumors via subxiphoid approach and lateral thoracic intercostal approach. Methods　A retrospective analysis was conducted on the clinical data of 50 patients who underwent RATS for anterior mediastinal tumor resection in the People′s Hospital of Guangxi Zhuang Autonomous Region from July 2021 to June 2025. According to the surgical approaches, the patients were divided into subxiphoid approach group(n=30) and lateral thoracic intercostal approach group(n=20). The baseline data, perioperative indicators, postoperative hospital stay, total hospitalization cost and the incidence of postoperative complications were compared between the two groups. Results　All the patients′ operations were successfully completed. Compared with the subxiphoid approach group, the lateral thoracic intercostal approach group had significantly shorter durations of operation and postoperative drainage tube retention(P<0.05), and significantly less intraoperative blood loss(P<0.05). However, there were no statistically significant differences in postoperative 48-hour drainage volume, and in Visual Analogue Scale(VAS) scores, C-reactive protein(CRP) level and white blood cell count on the first day after operation between the two groups(P>0.05). The postoperative hospital stay of the lateral thoracic intercostal approach group was significantly shorter than that of the subxiphoid approach group(P<0.05), but there was no statistically significant difference in the total hospitalization cost between the two groups(P>0.05). There was no statistically significant difference in the incidence of complications between the two groups(P>0.05). Conclusion　Compared with RATS via the subxiphoid approach, RATS via the lateral thoracic intercostal approach can shorten durations of operation and postoperative drainage tube retention, and postoperative hospital stay, and reduce intraoperative blood loss in treatment of anterior mediastinal tumors, and the surgical effect of RATS via the lateral thoracic intercostal approach is more advantageous.]]> 2025/10/31 0:00:00 1, ZHOU Yifan², SHEN Bin², HUANG Jianwei², ZHANG Chen²]]> PEI Shimin¹, ZHOU Yifan², SHEN Bin², HUANG Jianwei², ZHANG Chen² 3true ［Abstract］　Objective　To explore the safety and short-term efficacy of postoperative hyperthermic intrathoracic perfusion treatment(HITP) in patients with stages Ⅲ-Ⅳ thymoma who underwent tumor-reductive surgery to the most extent. Methods　A retrospective analysis was conducted on the clinical data of 17 patients with stages Ⅲ-Ⅳ thymoma who were admitted to the University of Hong Kong-Shenzhen Hospital from June 2022 to July 2025. All the patients underwent tumor-reductive surgery to the most extent and received postoperative HITP(with normal saline at 46-48 ℃ for 60 minutes, once every 24 hours with a total of 3-5 treatments). The patients′ perioperative complications, adverse reactions and survival outcomes were recorded. The follow-up methods included outpatient re-examination, phone calls and WeChat communication. Results　Among the 17 patients, 16 patients were completed 3 to 5 times of HITP as planned, while 1 patient was only completed 1 time of HITP. One patient experienced unbearable significant chest tightness after surgery, and the major adverse reactions in the other 16 patients were mild chest tightness and discomfort. No severe complications such as severe arrhythmia, respiratory failure, major bleeding and anastomotic fistula were observed. No obvious impairments of heart, lung, liver and kidney functions occurred. During the follow-up period of 1-38 months, all the patients survived, and thoracic recurrence occurred in 2 patients with stage ⅣA thymoma. Conclusion　The combined HITP demonstrates good safety and manageable adverse reactions in patients with stages Ⅲ-Ⅳ thymoma who underwent tumor-reductive surgery to the most extent. However, its long-term efficacy still needs further verification through prospective studies with large sample sizes and long-term follow-up.]]> 2025/10/31 10:05:06 1,2, PANG Dazhi^1,2, PENG Tao^1,2, YAN Jinjin^1,2, ZHANG Jitian^1,2, SHAO Guangqiang^1,2, LIU Zhihai^1,2, PENG Hao^1,2, TANG Ying^1,2]]> LIU Rutaiyang^1,2, PANG Dazhi^1,2, PENG Tao^1,2, YAN Jinjin^1,2, ZHANG Jitian^1,2, SHAO Guangqiang^1,2, LIU Zhihai^1,2, PENG Hao^1,2, TANG Ying^1,2 2true ［Abstract］　Objective　To explore the incidence and independent risk factors of complications after tubeless thymoma resection, and to provide a reference basis for the clinical optimization of perioperative management. Methods　A retrospective analysis was conducted on the clinical data of 80 patients who underwent tubeless thymoma resection in Nanxishan Hospital of Guangxi Zhuang Autonomous Region from January 2021 to July 2025. The patients′ general data, surgical-related indicators and postoperative complications were recorded. Univariate analysis was used to screen for the risk factors, and multivariate Firth-corrected logistic regression was used to analyze the independent risk factors. Results　In the 80 patients, 11 patients had postoperative complications, among which arrhythmia and incision fat liquefaction were the most common. Univariate analysis showed that the maximum diameter of tumors, Masaoka-Koga stage, myasthenia gravis, surgical method, duration of operation, intraoperative blood loss and duration of artificial pneumothorax were associated with the occurrence of complications(P<0.05). The analysis results of multivariate Firth-corrected logistic regression indicated that the longer maximum diameter of tumors, longer duration of operation and longer duration of artificial pneumothorax were independent risk factors for the occurrence of postoperative complications after tubeless thymoma resection(P<0.05). Conclusion　Tubeless thymoma resection is generally safe and feasible, but patients with longer maximum diameter of tumors, longer duration of operation and longer duration of artificial pneumothorax have a higher risk of complications. For the high-risk patients, preoperative assessment and perioperative management should be strengthened to reduce the incidence of postoperative complications.]]> 2025/10/31 10:05:06 XU Yi, LU Ting, XU Ke, FENG Xiaoyan, XIONG Rongsheng 1true